The human condition is currently an expression of high states of anxiety. This regrettable reality tends to obscure the truth about our identity. It is difficult to be aware of our True self when we suspect that the “other” is lurking around every corner waiting to do us harm. With so much of our energy being used in defense of a non-existent enemy we have little chance of feeling our True self which would express compassion not fear. The True self has no enemies.
American historian Richard Hofstadter remarked that American politics had a “paranoid style.” If he had known of the existence of the false self, Hofstadter could have explained that paranoia. Dani Shapiro, reviewing Jill Lepore’s latest book, The Mansion of Happiness, using her words and some of his own, describes in more detail what the false-self projections look like. “Americans talk paranoid and think paranoid; they use language of ‘heated exaggeration, suspiciousness and conspiratorial fantasy;’ they have a habit of worrying about dark goings-on by unnamed, mysterious plotters who lurk, disguised as honorable public servants, within the very halls of government.” It’s amazing that any rational policy comes out of Washington at all.
Let’s return to focusing on the differences between the false self and the True self. The following examples can aide us in seeing those distinctions. Failure to understand these differences and to modify our behaviors will doom humanity to needlessly squandering its resources on weapons systems, troops, planes, ships, drones, spies, caches of chemical/biological weapons, prisons, psychiatrists, hospitals, and domestic murder and mayhem. We all can recognize the foregoing as only a partial list of the consequences of believing in the illusion of the story we call P-B.
This is not an expression of compassion! The following story is about the false self, about fear, about selfishness, about an illusion and the resulting human reaction that represses our true identity and then causes us to project our fears onto a non-existent enemy, resulting in fundamentally self-destructive behaviors.
Our story begins with the controversy over the Affordable Care Act which would create an advisory board which could limit health care options for Medicare recipients. Labeling the advisory board a “death panel” the fear-driven reactions were intense although the Affordable Care Act does not take effect until 2014. The facts are that the provisions of the Act would improve the healthcare of Medicare recipients, including the end-of-life experience that is most misunderstood.
In truth, many Americans, who are in the throes of a terminal illness, currently experience a de facto death panel. Judith Martin points this out in her column, “We already have death panels in Colorado. It is the current health care system, which denies lifesaving medical treatment to low-income adults not yet 65 or disabled, who have no dependent children, do not have jobs that provide insurance or who can’t afford private insurance.”
What exactly is the current “death panel?” It is the Social Security Administration which decides who is disabled enough and indigent enough to be covered by Medicare and Medicaid health insurance when they do not qualify by age. In other words you cannot afford to become seriously ill until you are old enough.
Enter 59-year-old Sally (you guessed it—not old enough) who was ready to die seven months ago. Sally, like most responsible and able-bodied Americans worked all of her adult life, owned a home and raised two children. In 2007, she had to move out of her house and lost her job and insurance. She cleaned houses for five years to make ends meet. In January 2012, she was unable to work, she could not keep food down, her weight fell to 97 pounds and she was diagnosed with Chronic Obstructive Pulmonary Disease.
Where do people go who have no insurance? The ER, of course! Her friends drove Sally 30 miles to the nearest ER where she was treated for dehydration, given Zofran to stop her vomiting and sent home. Her next trip to the ER resulted in a diagnosis of a large stomach ulcer which needed immediate care by a private physician. Private physicians in the U.S. don’t treat people without health insurance.
We can see where this story is going and it is a narrative all too common in what is essentially an unconscious and heartless America. Sally applied to Social Security for disability insurance but the county does not give her enough ($188 a month) to cover the costs of her medication and prescribed inhaler. With an untreated ulcer, her weight continued to drop and she ended up in the ER with a massive kidney infection.
“If the affordable Care Act was in effect today, instead of 2014, Sally would immediately qualify for subsidized health insurance, and would not be waiting for the real death panel to decide whether she lives or finally dies as a result of her combined health problems.”
What Sally is waiting for today is a letter in the mail with the panel’s decision. Is America so afraid or so poor that it would actually let millions of its most unfortunate and destitute go without health insurance? Would a supposedly civilized nation be willing to let Sally die? We have learned that the collective American false self, unconscious and lacking in compassion is willing to look away and try not to think about the thousands of Sally’s facing an undignified and perhaps agonizing death.
This is an expression of compassion! The following story is about how the True self behaves when free and unhindered by doubt and suspicion.
We just learned about the real “death panel” not the one that Americans have recently become agitated about which, in fact, exists only in their overly anxious minds. Now let’s take a look at what a compassionate and conscious health care system would provide for Americans facing end-of-life issues. It’s called Death With Dignity and we all need to know about it because we may be called upon soon to choose to react or respond to this revolutionary idea in health care.
In 2008, Dr. Richard Wesley received a diagnosis of amyotrophic lateral sclerosis (Lou Gehrig’s disease). Most Americans receiving such a diagnosis would be facing a long unpleasant and undignified death. Not Richard Wesley. Because he lives in a state with a relatively enlightened and compassionate population, he takes comfort in knowing that he can decide exactly when, where and how he will die.
Anyone living in Washington or Oregon, both of which have passed a Death With Dignity Act, can choose to die peacefully within minutes by taking a lethal dose of barbiturates given to them by their personal physician.
How does it work, this Death With Dignity provision? It is really quite simple and non-controversial if we can get past the reactions of the false self; more about those reactions in a moment. What can be the objection to giving a person more control over their life’s experience, giving them a choice to make the end of their lives more comfortable? Here is how it works. Two physicians must confirm that a patient has six months or less to live. The request for the drugs must be made twice by the patient, fifteen days apart, before they are handed out. They must be self-administered meaning that the patient is the sole determiner of when, where and how they will die.
We might think that most physicians like Dr. Wesley, who is a pulmonologist, would be in favor of letting their terminally ill patients have the option of a dignified and less painful death. Dr. Steven Kirkland, who is Dr. Wesley’s pulmonologist, did not hesitate to write the prescription. “I’ve seen a lot of bad deaths,” Dr. Kirkland said, “Part of our job as physicians is to help people have a good death, and frankly, we need to do more of that.”
But remember, doctors have a false self too and Drs. Kirkland and Wesley are so far atypical of American physicians. “The American Medical Association opposes physician-assisted dying. Writing prescriptions for the drugs is antithetical to doctors’ role as healers, the group says….I didn’t go into medicine to kill people,” said Dr. Kenneth R. Stevens, an emeritus professor of radiation oncology at Oregon Health and Science University and vice president of the Physicians for Compassionate Care Education Foundation. The reaction of Dr. Steven’s false self reveals something other than compassion.
Fear was able to defeat Death With Dignity initiatives in Hawaii, California and Maine and voters in Massachusetts will consider a ballot initiative in November. What was the paranoid opposition to Death With Dignity worried about?
The Death With Dignity Acts have been in place in Oregon and Washington since 1997 and 2009 respectively. Some officials in those states thought that thousands of people would migrate to these states to get the drugs. That has not happened. Barbara Glidewell, an assistant professor at Oregon Health and Science University said, “There was a lot of fear that the elderly would be lined up in their RV’s at the Oregon border.” That hasn’t happened either.
Some critics feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. This has not happened but as we learned with the story of Sally, the poor might welcome a death with dignity as long as the rest of us are willing to “discard” them or to let them suffer, bereft and alone.
So what has happened since 1997 and through 2011? Let the facts speak for themselves. What demographic has availed themselves of the Death With Dignity Act? The well-educated, financially comfortable, white American rather than the poor and destitute minority are more representative of those asking for the drugs.
Even the reasons given for the requests surprised the researchers. Dr. Linda Ganzini, a professor of psychiatry at Oregon Health and ScienceUniversity, published a study of 56 Oregonians in 2009. “Everybody thought this was going to be about pain. It turns out pain is kind of irrelevant.” Her study revealed that the most important reasons for requesting the barbiturates was that patients wanted to remain autonomous, be in control and to remain at home.
What are the specific challenges facing those who opt for DWD? Incidentally, the number of men and women choosing DWD are roughly the same with a median age of 71. In Oregon eighty-one percent have had cancer, and 7 percent A.L.S with lung disease, heart disease and a number of other illnesses accounting for the rest. The statistics in Washington are similar.
And finally let’s look at some other stats. The number of people taking advantage of the law in both states is small but gradually increasing. In Oregon in the early years the number of residents who died using their drugs accounted for one in 1,000 deaths and has risen to one in 500 in the 15 years since the law was enacted. The total DWDA deaths in Oregon is 596 and 157 in Washington which is roughly one in 1,000 Washingtonians who died during the three years tabulated.
As is often the case, the panic demonstrated by the false self in a state of paranoia related to DWD, was much ado about nothing or at least not what its overactive imagination was concerned about. What we should be concerned about is being in service to others and expressing the special gift that each of us brings to this life, because after all our essence is one of compassion, not fear.
We live in fear because something within whispers a warning that we might be faced with an early or an agonizing death in a callous community that is capable of ignoring what happens to the old, the poor, the vulnerable and the disabled. We are understandably frightened by this reality.
It’s only a matter of time before the fate of “death panels” and a Death With Dignity initiative shows up at a polling place near you. How will you vote?
References and notes are available for this essay. Find a much more in-depth discussion in books by Roy Charles Henry:
Where Am I? The First Great Question Concerning the Nature of Reality
Simple Reality: The Key to Serenity and Survival